Immunologic agents

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N203 IMMUNOLOGIC AGENTS

Objectives: Upon completion of this class, the student will be able to:

1. describe the life cycle of HIV;

2. list the four classifications of antiretroviral therapy;

3. discuss the prototypes of HIV and AIDS drugs

4. discuss post-exposure prophylaxis for health care workers;

5. describe a prototype vaccine administered to adults;

6. discuss how to apply the nursing process to safe administration of these drugs.

Immune response: Inflammation, Cell mediated response [T-Cells] à leukocytes, antibody mediated [B cells]. Innate vs acquired immunity. Acquired: antibody mediated, natural/artificial

What screws up our immune system; certain meds, age, malnutrition, stress, chronic illness. And HIV.

I. HIV, AIDS

A. Pathology:

B. Lab and diagnostic tests

C. HAART:

D. Life cycle of HIV:

CD4 receptors are on T helper cells and also macrophages.

II. Antiretroviral therapy

A. Goals:

1. Suppress viral replication to slow decline in number of CD4 cells

2. Suppress viral replication to undetectable levels

3. Reduce incidence and severity of opportunistic infections [keep your t cells around]

4. Minimize adverse effects of antiretroviral therapy [lots of people can’t tolerate AZT—too many side effects; like chemotherapy]

5. Improve quality of life

6. Improve survival and reduce morbidity

B. Classes

1. Nucleoside analogues: act by inhibiting HIV reverse transcriptase so reduce viral replication

2. Nonnucleoside analogues: act by inhibiting HIV reverse transcriptase so reduce viral replication

3. Protease inhibitors: block protease, so suppress production of infectious virions in infected cell populations

4. Fusion inhibitors: bind to viral particles and prevent adhesion to CD4 cells

5. HAART: standard of care to treat HIV infection [highly active antiretroviral therapy= means combination therapy with more than one drug]

These drugs are rough on the liver

Zidovudine (AZT) first HIV drug developed in the 80’s. Used for post-exposure prophylaxis and maintenance.

• use: HIV infected clients and prevention of maternal-fetal HIV transmission

• action: inhibits viral enzyme transcriptase: being incorporated into growing DNA chains by viral reverse transcriptase, thereby terminating viral replication.

• adverse: anemia, seizures, neutropenia [bone marrow impact] [Drug guide: Bone marrow depression, granulocytopenia, anemia]

Efavirenz (Sustiva)

• use: treat HIV-1 infections with other anti-retroviral agents—used in a cocktail

• action: binds to reverse transcriptase—halts RNA change to DNA, blocks enzyme activity and HIV-1 replication

• adverse: [drug guide: Stevens-Johnson syndrome, toxic epidermal necrolysis] allergic,

convulsions, liver failure, suicide

• caution: history of mental illness, drug abuse

Protease Inhibitors: Lopinavir/Ritonavir (Kalestra)

• use: treatment of HIV-I infections with other agents

• action: inhibits protease, prevents production of mature HIV particles

• adverse: hyperglycemia, DM,[convulsions, paralysis, palpitations, tach]

Protease inhibitors changed AIDS into a chronic, not fatal disease.

D. Nursing process

Assess: signs of infection, quality of GI function, T Cell count [on CBC], liver panel, adverse reactions, what Rx’es do they have, where are their meds, how to make the schedule work?

Nursing Diagnoses: risk for infection, altered nutrition, knowledge deficit, inadequate thermal regulation, interrupted family process, pain, anxiety, fear,

E. Postexposure prophylaxis

III. VACCINES

20 infectious diseases that are preventable with vaccines.

A. Immunity

1. active

2. passive

B. Immunizations

1. childhood

2. adult

3. travel

C. Prototype: Varicella (Varivax)

1. use: prevention of chickenpox

2. action: stimulates active immunity against natural disease

3. adverse: anaphylaxis, thrombocytopenia, Stevens-Johnson syndrome [skin rash]

D. Nursing process